Long-awaited report to call for overhaul of mental-health treatment

The nation’s first-ever national mental-health strategy is expected to call for an overhaul of services for children and youth — an under-resourced and fragmented system Canada’s former mental-health commissioner says is in "desperate" need of repair.

Six years in the making and due for public release on Tuesday, the strategy will recommend national priorities for prevention and treatment of the leading cause of disability in Canada. Mental illness costs the economy an estimated $51 billion annually in health care and lost productivity.

The strategy is also expected to address the psychological health of employees in the workplace and call for a more integrated system to improve access to treatment and services across a person’s lifespan. Only a third of adults and one in four children who need mental-health services in Canada actually receive them.

"The system can become significantly more efficient and effective without having to spend a whole lot more money, which is not to say it doesn’t need money — it does, because it’s under-serviced," former Liberal senator Michael Kirby, who recently stepped down as chair of the Mental Health Commission of Canada, told Postmedia News.

Kirby declined to discuss specifics of the commission’s strategy. But he said that, "Even if you only attack those two areas (children and youth and workplace mental health) and if you focused on making the system more efficient by stopping some of the duplication and by getting much better coordination on the ground, you could have a very dramatic impact."

According to the Public Health Agency of Canada, 20 per cent of Canadians will experience a mental illness during their lifetime. Yet public health spending on mental health is lower in Canada than in most developed nations.

"The worst part of the system is the children and youth system, and that’s for a whole variety of reasons — not the least of which is the stigma and therefore the reluctance of some parents to try to get their children help and admit that their child has a mental-health problem," Kirby said.

Seventy per cent of mental illness in adulthood has its onset in childhood. "And yet only 15, 16 or 17 per cent of those get diagnosed and treated while they’re still under the age of 20," Kirby said.

"People grow up, they become adults with mental illness, the illness gets worse ... Those people end up very typically needing social assistance, needing supportive housing; they end up on the street, they end up in prison, and they end up costing society a whole lot more money."

Families are frustrated by the scarcity of services, he said, the difficulty of finding their way through a confusing system and a lack of publicly funded psychological counselling.

"If you can’t afford that, your child doesn’t get treated, you wait for a child psychiatrist and you wait, in most places in the country, on the order of a year," Kirby said.

"I’m not talking six or eight weeks. There’s an area where help is desperately needed."

He hinted that the strategy may address the controversial issue around whether parents or caregivers should be given access to medical information about their child once they reach the age of majority.

"There’s no simple solution to that, it’s going to require a lot of thought, but it clearly requires some element of rebalancing of the rights of the patients versus ensuring the patient gets the best health care possible, which means some information to the caregivers," Kirby said.

The need for reform is equally desperate, he said, in workplace mental health. Mental illness is the fastest-growing cause of short and long-term disability, he said while drugs used to treat mood disorders, stress, anxiety and depression are the fastest growing part of any employer’s drug plan.

Many workers are fearful of admitting to depression or other mental illness for fear they’ll be fired, Kirby said. That creates the problem of presenteeism, he said: "So they come to work and work anyway, so they’re there, but they’re not functioning at the level they’re capable of functioning."

According to a recent survey for the Conference Board of Canada, 44 per cent of Canadian employees have dealt with mental-health issues at some point; 12 per cent are currently experiencing mental-health conditions, the survey suggests. Yet nearly half of managers said they have had no training in how to work with employees suffering a mental illness.

A draft strategy leaked last summer was criticized for emphasizing "recovery" and self-care and not putting enough focus on the role of psychiatric drugs in the treatment of severe mental illness.

Kirby said the criticism was heard, and has been "corrected" in the final draft.

"The criticism was a valid criticism — there was not adequate focus on the fact that there is a significant role for psychiatrists and psychiatric drugs to play in the treatment of severely mentally ill people."

The mental-health commission was born from the groundbreaking 2006 Senate committee report, co-authored by Kirby, called "Out of the Shadows at Last" — the most exhaustive study of mental health in the nation’s history, known as the Kirby Report.

Thousands of people participated in meetings and online discussions to help shape the strategy, which is also expected to tackle deep-seeded stigma and discrimination faced by the mentally ill.

In a 2008 survey conducted on behalf of the Canadian Medical Association, nearly half (46 per cent) of those polled believed that mental illness isn’t always "real" but rather an excuse for poor behaviour and personal failings.

"Mental health funding is always at the bottom of the pile," said Dr. Fiona McGregor, president of the Canadian Psychiatric Association and a hospital and community psychiatrist from Vernon, BC.

She pointed to the recent cutting of key medical jobs in the military involved in suicide prevention and post-traumatic stress disorder as evidence of how, despite "all this talk", mental health funding is often an easy target.

"We want a system with measurable goals for access and quality. And we want accountability and adequate funding for mental health," McGregor said.

Evidence shows that "if you can get people engaged early and treat them early, that people have a hugely better outcome — they might be able to maintain employment, friendships and a relatively normal life.

"If they’re allowed to have repeated relapses because they’re not being followed up carefully, and there aren’t enough services in place to help them, then you’re left with people who become severely and profoundly disabled."

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